Mgr Performance Audit, Medicare-41335 - (US-OH-Mason - 45040)

Minimum Education: Tech School
Job Type: Full Time
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Responsible for Medicare Advantage Risk Adjustment/ Revenue Enhancement department policies and procedures and for directing performance audit activities for CMS, delegated entities/ vendors and internal areas that may include multi-function, multi-system, multi-states, or multiple business units to ensure performance meets or exceeds CMS and WellPoint Compliance requirements. Primary duties may include, but are not limited to: Coordinates all activities related to CMS audits (eg: RADV). Reports service performance to applicable leadership and regulatory or oversight agencies. Directs and ensures that audit scope and audit areas follow applicable guidelines for sampling, auditing and reporting performance. Implements applicable audit and reporting guidelines. Leads performance repairing program. May direct and monitor performance guarantee implementation, processes, reporting and performance improvement. Establishes and coordinates compliance plan activities within the Business Unit. Hires, trains, coaches, counsels, and evaluates performance of associates.


Skills:
Requires B.A. or B.S. degree; and a minimum of 5 years experience in related area; or any combination of education and experience which would provide an equivalent background. Internal, public audit, quality assurance, project management and CMS/ Medicare Advantage experience preferred. Any applicable certifications preferred

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